If you live in Vermont – or you’re considering living there – you’ve probably heard about the state’s all-in approach to healthcare reform. More than any other state, Vermont is going above and beyond with ACA implementation, requiring all individual policies to be purchased through the exchange and planning a transition to a single-payer system in 2017.
But there are plenty of other aspects of overall public health and healthcare reform that might be of interest to you. Here’s a summary of health and healthcare in Vermont:
Vermont health ratings
When it comes to overall health, Vermont is ranked second in the nation by The Commonwealth Fund’s Scorecard on State Health System Performance 2014. The state held the same second place spot in 2009 as well (only Minnesota outperforms Vermont on The Commonwealth Fund’s rating scale). Vermont’s Scorecard includes details on how the rankings are determined.
Vermont is also ranked second out of the 50 states in the 2013 edition of America’s Health Rankings (on this scoring system, Hawaii is the only state to top Vermont).
Despite being ranked above nearly all states, there are still challenges in Vermont: low levels of immunization (this is relatively common in affluent states with a highly educated population) and a corresponding high rate of pertussis, along with high incidence of binge drinking.
But Vermont’s strengths in healthcare obviously outweigh its challenges. The state has a well-educated population with the 5th highest high school graduation rate in the country. Vermont also has a low percentage of residents without health insurance, and a low violent crime rate.
Trust for America’s Health published 2014 Key Health Data About Vermont that includes rankings for the state across a wide variety of specific diseases and health outcome predictors. And this interactive map created by the Robert Wood Johnson Foundation lets you compare health factors and outcomes on a county-by-county basis in Vermont.
Vermont and the Affordable Care Act
In 2010, both of Vermont’s U.S. Senators – Bernie Sanders and Jeff Leahy – voted yes on the Affordable Care Act. In the House, the lone Vermont Representative also voted yes. All three are still in congress and still supportive of the health care reform law.
Governor Peter Shumlin is not only supportive of the ACA, he’s the first governor in the country to actively pursue the clause in the law that allows states to take it one step further and eventually implement a state-based single payer system. Green Mountain Care could begin as early as 2017, but the state still has a lot of hoops to jump through in order to implement the single-payer system, as well as a $2 billion funding shortfall that must be addressed.
In November 2014, Governor Shumlin defeated Republican Scott Milne by about 2,400 votes. But since neither candidate garnered more than 50 percent of the popular vote, the state legislature will determine the outcome of the governor’s race when they convene in January.
Milne has said that the state “should have been content with the (federal) Affordable Care Act” instead of forging ahead towards a single payer system. Given the current uncertainty with regards to the outcome of the election, it’s unclear whether the state’s path towards single payer will remain in place. If Milne become Governor, Vermont could end up on a different course.
For the time being, Vermont has expanded Medicaid under the ACA and is running its own exchange, Vermont Health Connect. Unlike most states, Vermont does not allow policies to be sold outside the exchange, so the exchange has been very successful at enrolling a large percentage of the state’s eligible population (85 percent by the end of the first open enrollment period).
How did the ACA help Vermont?
In 2012, about 6.8 percent of Vermont residents did not have health insurance – far lower than the national average. – the fourth highest rate in the country. The state has not yet released their updated uninsured rate for 2014, but 36 percent of the uninsured population was expected to be eligible for expanded Medicaid or CHIP, and the exchange had signed up 85 percent of its potential private plan enrollees by the end of the first open enrollment period. It stands to reason that the total uninsured rate in Vermont has fallen significantly from its pre-2014 rate.
Vermont enrollment in QHPs
Near the end of 2013, the Kaiser Family Foundation estimated that the potential market for the exchange in Vermont was 45,000 residents, and that 27,000 of them would qualify for premium subsidies to reduce the cost of their coverage. By mid-April 2014, at the end of the first open enrollment period, almost all of them – 38,048 people – had finalized their plan selections in the Vermont exchange.
Two carriers are participating in Vermont Health Connect: Blue Cross Blue Shield of Vermont and MVP Health Care. Rates in Vermont for individual health insurance are the fifth highest in the nation, partly because of the low level of competition in the exchange, and partly because the population is older than average and the state uses community rating, with premiums that are not based on an insured’s age.
Vermont Medicaid/CHIP enrollment
Utilizing federal funds to expand Medicaid eligibility to 138 percent of poverty has played a significant role in Obamacare’s success in Vermont. As of mid-April, 41,704 people had enrolled in Medicaid through the Vermont exchange. Eligible applicants can enroll in Medicaid at any time during the year, so that number is continuing to increase, further reducing the state’s uninsured rate.
What is Vermont’s health insurance history?
Before the ACA, Vermont was one of only a handful of states where individual health insurance was not medically underwritten. (This had been the case since 1992.) That means that medical history was not used to determine eligibility for coverage. In addition to guaranteed issue policies, the state also utilized community rating, so premiums were not higher for older insureds.
Although these are good measures to protect consumers, they are not necessarily beneficial for health insurance carriers looking to make a profit, and the market had destabilized significantly by 2006. The legislature passed a measure in that year that contained a variety of reforms, and the ACA later piggy-backed nicely on what Vermont was already doing.
Because Vermont had a law that required all policies to be guaranteed issue, there was no need for a state-run high risk pool prior to the ACA, but the law did still provide PCIP coverage in Vermont starting in 2010.
State-based health reform legislation
Vermont’s proactive approach to healthcare reform means there is plenty of healthcare-related legislative action in the state. Here’s a summary of recent Vermont bills: